Since March 2019, the bloodless emergency services have been asking for more resources. Today, it is the pediatric services that are sounding the alarm.
For ten months, nursing staff have been worried about the state of health of the public hospital, especially in the emergency departments on strike. A new sign of this rise in tension, they are again mobilized for a day of demonstrations, all over France, Monday, January 20. The crisis is now spreading to all floors of the hospital: bed closures and the lack of personnel also affect the pediatric emergency and intensive care units, which are forced to transfer children ”in distress” tens of kilometers from their parents’ homes.
At the start of the year, and at the height of winter illnesses, the pediatric teams are alerting the public authorities to the degradation of their services and the possible risk of a health crisis. Doctors, nurses and parents testify to an alarming daily life.
“This transfer of newborns is a wake-up call”
Every day, when Marie’s father * pushes the door of the neonatal intensive care unit at Bicêtre hospital (Val-de-Marne) to see his daughter there “Very premature”, he can read, on a placarded poster, the number of children refused because of the lack of staff. Since the end of November, he and his partner have been going back and forth to the bedside of their child hospitalized since birth. The delivery was scheduled at the Trousseau Hospital in Paris, which is closer to their home. But the saturation of it and the health complications of Marie, led them to more than an hour and a half from home. “It would have been hell to deal with if my daughter had been hospitalized further away ”, admits the dad.
Some parents did not have the relief to find a solution nearby. “Between October and mid-December, we had to transfer twenty-five infants more than 150 km from their parents’ home, due to a lack of pediatric space in one of the three authorized hospitals in Ile-de-France ” notes Stéphane Dauger, head of the pediatric emergency department at Robert-Debré hospital. In the midst of the winter peak of bronchiolitis, the hospitals of Bicêtre, Garches and Necker had to close beds.
Same observation in the provinces: on January 1, the Le Mans hospital center (Sarthe) had to close its pediatric intensive care unit for lack of doctors, forcing parents and children to go nearly 100 kilometers away, to Tours or Angers.
“This transfer of newborns is a wake-up call for our system”, notes Sophie Branchereau, head of the pediatric surgery department in Bicêtre. Stressing not only the increased vital risk for the transferred child, but also the economic precariousness in which parents can find themselves when they have to ensure a presence far from their work and home.
Since the arrival of Dr Branchereau in 1995, Bicêtre’s pediatric surgery department has grown from twenty-four to sixteen beds. “During the holidays, we go to eight beds for a single nurse, whereas we should rather be six beds per nurse”, laments the surgeon. The daily management of pediatric beds has become “complicated ”, forcing staff to work in “degraded.” “We hit rock bottom”, regrets the head of service.“If I have a sick nurse, I have to close a bed and refuse transfers.”
A tension accentuated by the difficulty of pediatric emergency services to manage the flow of arrivals. Unlike general emergencies, pediatric emergencies are few in number in France. In 2015, the Ministry of Solidarity and Health identified 723 emergency services in mainland France and in the overseas departments and regions, of which only 13% specialized in pediatrics. “For lack of space, pediatric emergencies are forced to moderate by inviting parents of sick children to return home, after several round trips”, explains Barbara *, nurse in a pediatric intensive care unit in Ile-de-France. “But the situation can quickly deteriorate in a suffering child. The parents then call the Samu or the fire brigade, who bring them directly to the pediatric intensive care unit. ” The latter found himself “saturated” in December, no longer able to evacuate hospitalized children for lack of so-called “downstream” beds, these beds available in other departments.
Parents who have become whistleblowers
This situation leads caregivers to regularly exceed the number of babies per nurse, says Isabelle *, a neonatal medical aide in the Grand Est. Last week, she had to urgently receive a very premature baby when they were only two for eight newborns. “The time spent with each one is ridiculous. We make sure that the baby is clean, that he has eaten and received his care, to the detriment of his well-being. We no longer have the time to support the parents, and it is frustrating. We don’t work in a good way ”, the nurse despairs.
“Belly ball”, “fatigue”, “fear of making a mistake”, staff work to the limit and fear the accident. “Our strength remains our mutual aid”, Barbara reassures herself. Day and night, she and her colleagues make sure “Emotional balance” children, but also that of parents.
In the corridors of the neonatal intensive care unit in Bicêtre, Marie’s father observes the incessant comings and goings of nurses and nursing assistants at the bedside of these “Great fragile” who can see their oxygenation or heart rate drop at any time.
With a “energy” and an “Unparalleled passion”, reports Marie’s father, nurses do “buffer” between worried and stressed parents and their deteriorating daily life. “Given their level of responsibility and their degree of investment at this level of salary, I understand their demands”, admits Marie’s father. “The public hospital is a treasure that must absolutely be kept and, within it, there is a jewel: the pediatric sheave.”
It was without hesitation that he signed the petition “Save pediatric resuscitation: the call of parents”, launched by a group of parents who have also been familiar with pediatric services. The petition collected more than 40,000 signatures in one week. Pauline Lavaud, one of its co-editors, said to herself “reallyworry”Because neither the caregivers nor the doctors manage to make themselves heard with the government. “So, we parents, we become whistleblowers because we don’t want to wait for a tragedy.”
This mother, who lost her son some time after his birth, knows how much every minute counts when life hangs by a thread. “We cannot go to an additional level of risk for lack of space”, she exclaims. Quoting in the wake of one of the last testimonials she received on the collective’s Facebook page, where a mother says she took her 6-week-old daughter to the pediatric emergency department of Necker hospital for severe bronchiolitis at the end of October. “Unable to be taken care of on the spot, her daughter was transferred to Poissy, where her situation deteriorated. She had to be transferred to intensive care in Orléans again for a week. ” Or this other mother whose baby was in respiratory distress at birth. The hospital where she had just given birth was not equipped to take care of her. “The medical teams had to call eleven hospitals before they could find a place for him.”
Who to operate first?
Administrative bodies, such as the Ile-de-France Regional Health Agency (ARS) and the AP-HP claim to be “Aware of the problem”. Every day, their managers take stock of the situation. “On high alert on staff tensions within the hospital”, the ARS says it is implementing temporary solutions “Easy” to be deployed at short notice, such as postponing non-emergency operations, the occasional opening of intensive care beds or the use of temporary staff.
Solutions that have limits according to Doctor Sophie Branchereau for whom postponing operations, in pediatrics, is “Almost impossible.”“We cannot anticipate because often at the time of the operation the child is ill. Colds, gastro… 30% of our interventions are thus canceled. ” With her teams, she is working on a permanent reorganization, “Just in time.” Patient arrivals are linked, operating theaters and beds are constantly occupied, leaving only “very few margins ”. “Outside the margins, it’s security”, insists the head of department.
As for the constrained choice, due to lack of space and staff, of having to choose which operation to perform as a priority between peritonitis, cancer or a rare disease, it is an exercise “Morally complicated”, notes the surgeon. In a crisis situation, its teams cancel what is not an extreme emergency. “But pediatric cancer can quickly become an emergency”, she recalls. So hospital directors regularly call on temporary staff. “Paid more” and “It destroys the already tense atmosphere”, notes the head of department.
Another downside for the pediatric emergency: recourse to the private sector is impossible.
So the public hospital turns to the outpatient to free up beds: the patients are sent home with a protocol to follow. But this is not necessarily suitable in all cases. “The more you have a population in social suffering, with problems of housing, language, accessibility to a hospital in case of need, the less you can do it”, criticizes the surgeon. “We are not against the ambulatory but we must be able to welcome those who need to be welcomed.”
For his part, Marie’s father recognizes that he and his partner could not have taken on the care of their daughter born prematurely. “When she leaves the hospital in mid-February, the bill will be around 300,000 euros I think”, calculates the young dad. Before concluding, grateful: “It was national solidarity that saved our child.”
* The first names have been changed at the request of the interested parties